Nourkami-Tutdibi Nasenien, Tutdibi Erol, Faas Theresa, Wagenpfeil Gudrun, Draper Elizabeth S, Johnson Samantha, Cuttini Marina, Rafei Rym El, Seppänen Anna-Veera, Mazela Jan, Maier Rolf Felix, Nuytten Alexandra, Barros Henrique, Rodrigues Carina, Zeitlin Jennifer, Zemlin Michael
Saarland University Medical Center, Hospital for General Pediatrics and Neonatology, Homburg, Germany.
Saarland University Medical Center, Institute of Medical Biometry, Epidemiology and Medical Informatics, Homburg, Germany.
Front Pediatr. 2021 Nov 15;9:747203. doi: 10.3389/fped.2021.747203. eCollection 2021.
As childbearing is postponed in developed countries, maternal age (MA) has increased over decades with an increasing number of pregnancies between age 35-39 and beyond. The aim of the study was to determine the influence of advanced (AMA) and very advanced maternal age (vAMA) on morbidity and mortality of very preterm (VPT) infants. This was a population-based cohort study including infants from the "Effective Perinatal Intensive Care in Europe" (EPICE) cohort. The EPICE database contains data of 10329 VPT infants of 8,928 mothers, including stillbirths and terminations of pregnancy. Births occurred in 19 regions in 11 European countries. The study included 7,607 live born infants without severe congenital anomalies. The principal exposure variable was MA at delivery. Infants were divided into three groups [reference 18-34 years, AMA 35-39 years and very(v) AMA ≥40 years]. Infant mortality was defined as in-hospital death before discharge home or into long-term pediatric care. The secondary outcome included a composite of mortality and/or any one of the following major neonatal morbidities: (1) moderate-to-severe bronchopulmonary dysplasia; (2) severe brain injury defined as intraventricular hemorrhage and/or cystic periventricular leukomalacia; (3) severe retinopathy of prematurity; and (4) severe necrotizing enterocolitis. There was no significant difference between MA groups regarding the use of surfactant therapy, postnatal corticosteroids, rate of neonatal sepsis or PDA that needed pharmacological or surgical intervention. Infants of AMA/vAMA mothers required significantly less mechanical ventilation during NICU stay than infants born to non-AMA mothers, but there was no significant difference in length of mechanical ventilation and after stratification by gestational age group. Adverse neonatal outcomes in VPT infants born to AMA/vAMA mothers did not differ from infants born to mothers below the age of 35. Maternal age showed no influence on mortality in live-born VPT infants. Although AMA/vAMA mothers encountered greater pregnancy risk, the mortality and morbidity of VPT infants was independent of maternal age.
在发达国家，由于生育年龄推迟，几十年来孕产妇年龄（MA）不断增加，35至39岁及以上的怀孕数量也日益增多。本研究的目的是确定高龄（AMA）和极高龄孕产妇年龄（vAMA）对极早产儿（VPT）发病率和死亡率的影响。这是一项基于人群的队列研究，纳入了来自“欧洲有效的围产期重症监护”（EPICE）队列的婴儿。EPICE数据库包含8928名母亲所生的10329名VPT婴儿的数据，包括死产和终止妊娠情况。分娩发生在11个欧洲国家的19个地区。该研究纳入了7607名无严重先天性异常的活产婴儿。主要暴露变量是分娩时的孕产妇年龄。婴儿被分为三组[参考组18 - 34岁，AMA组35 - 39岁，极（超）高龄组AMA≥40岁]。婴儿死亡率定义为出院回家前或进入长期儿科护理之前的院内死亡。次要结局包括死亡率和/或以下任何一种主要新生儿疾病的综合情况：（1）中度至重度支气管肺发育不良；（2）定义为脑室内出血和/或脑室周围白质软化的严重脑损伤；（3）严重早产儿视网膜病变；（4）严重坏死性小肠结肠炎。在使用表面活性剂治疗、产后皮质类固醇、新生儿败血症发生率或需要药物或手术干预的动脉导管未闭方面，各孕产妇年龄组之间无显著差异。AMA/vAMA母亲的婴儿在新生儿重症监护病房（NICU）住院期间所需的机械通气显著少于非AMA母亲所生的婴儿，但在机械通气时长以及按胎龄分组分层后无显著差异。AMA/vAMA母亲所生的VPT婴儿的不良新生儿结局与35岁以下母亲所生的婴儿并无不同。孕产妇年龄对活产VPT婴儿的死亡率无影响。尽管AMA/vAMA母亲面临更大的妊娠风险，但VPT婴儿的死亡率和发病率与孕产妇年龄无关。
